HomeMy WebLinkAbout0827 OEPA[iMENT OF iME TREIlSU~1f-NTERNAI RFVENUE SENKF For OP+iorai Ux Br Recordng Of~ce
Forro 668
~~v. ~-~o~ ' - CER~IGTE OF RELEASE OF fEDQAI TAX UEN F1~EO ~NQ RECOR~
D~STRI SERIAL NUMBER tT.IYCiE COIiNYY Ft~.
~ t~~ 215341 B 195 P 1284 ~toCE~ POitA~S ~
CIERK ttc;~Utt COURT ~
I he~eby certify that as to the following-~omed taxpoyer the requirements of Section RfCORF~ VER~~tEO..~~,
6325(0~, Internal Revenue Code, have been sotisfied with respect to the taxes enu-
merated bebw, together with all stotutory additions provided by Section 6321; and ~ t3 io ~9 ~Y t~~
thaf the lien for such taxes ond statutory oddifions hos thereby been releosed• The M
proper ofFice~ in the o~whese noticq„pf inta~nal revenue tax lien was 61ed on
Septem r 9 , 19 /1 Qu~rized to Make oototion
on his books to show the releose of said lien, insofor as the lien ~elotes to the follow- `~31~4
ing taxes.
NAME OF TAXPAYER
~ f. ~ JtY~I~ ~i
RE SIDENCE
~1r~ _
n~l+Ms !'SI~•~~
UNPAIO 6ALANCE
KIND OF TAX TAX PERIOD ENDED ASSESSMENT OATF IDENTIFYING NUMBER OF ASSESSMENT
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' ~ l66-]b~ a6i.aT
i ~,oiro 5-~-n
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~ PLACE OF FILlNG ~
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~ j~,~ Q~~ TOTAL s ~d~
n+~i'M~ nf•~
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_ `d1/ITNESS m7 hand ot Jacksonville, Florida , on rh~s,
~
rS
e~~ 203 826
rime 2[td ~y of June , 19 72
~ ~;GN URE T1TLE
~ Jac rant Chief, Special Procedures Staff
~
~ TE: Cert~fic of officer ov ed by low to take ockrawledyments is nol essenl~ol to the vohd+y of Notice of federal Tox l+en G.C.M.
26a19, C.B SO-51, 125.) jgd
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PART 3-To be used for recordin~ purposes
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